Taking the fear out of lung nodule detection

When it comes to keeping good health and doctor’s visits, the notion of receiving feedback on our bodies would make anyone feel a little wary. And when we get upsetting news, the stress we feel can often create mental strain and affect our day-to-day life. In the case of lung nodule detection, not knowing exactly what to expect often puts patients in a state of anxiety and fear. At Providence St. Vincent Medical Center’s Lung Nodule Clinic, patients often come in with a heightened sense of alarm. We therefore aim to mitigate distress by addressing a patient’s chief concern from the very beginning: “Is my lung nodule cancerous or not?”

Heather Merry, M.D., a Providence thoracic surgeon, saw a real need to comfort those with lung nodules before the worrying set in. “We created the program because we wanted a clinic that can accommodate patients quickly. Addressing their concerns helps ease their mind and lessen the anxiety around lung nodules.”

“At our Lung Nodule Clinic, we have daily appointments available for people who have been told they have a lung nodule and aren’t sure what to do. We review their images and come up with a tailored personal plan for next steps. And we take great care to explain exactly why we’re taking those next steps.”

Not just for lung nodules, the clinic helps patients dealing with various types of lung- and chest-related ailments, including infections and breathing problems. And while not all cases of lung nodules are cancerous, patient cases are always followed up to ensure that a nodule that wasn’t previously cancerous doesn’t change its state over time. Interestingly enough, lung nodules are often detected when a patient comes in for a completely unrelated issue.

“Sometimes, patients come in to get a CT scan for their kidney stones. Because of the improved technology of our scanners, we are able to detect nodules as small as one to two millimeters. When we notice a spot on their lung, the patient is often surprised,” says Dr. Merry.

Since anxiety around lung nodules stems from not knowing the full nature of the symptoms, the first thing Dr. Merry does when she discovers them on her patient’s lungs is to explain nodules in their entirety. “Lung nodules are small or oval shaped growths in the lung that are comprised of abnormal tissue. They are usually smaller than three centimeters. There are essentially two types of nodules: benign and malignant. In most cases, smaller lung nodules are benign. Nodules can be caused by multiple things such as cancer, inflammation, previous infections, and granulomas – a mass of tissue that the body produces to wall off an infection.”

“When we detect a spot, we don’t just acknowledge that it exists. We examine all the features of the nodule and take into account any reassuring aspects of it. We never dismiss a spot as not being cancerous, because truthfully that isn’t the case sometimes,” she goes on to say.

“Additionally, as our technology improves, the level of detection of nodules has improved. A vast majority of nodules are benign, and we help patients understand that so we can take care of it early and diminish any potential risk.”

While lung nodules can be brought on by specific lifestyle habits, they can often come out of nowhere as well. “One of the great myths of lung cancer is that it only happens to people who smoke. Even those who have never smoked can be diagnosed due to their environment and lifestyle habits. However, the most common risk factors for lung nodules include a history of smoking, which I describe as likely smoking a pack a day for 30 or more years, or those who are currently smoking or quit smoking within the last 15 years. One great thing Medicare has done recently is that they’ve started paying for lung cancer screenings. If patients are notified that they have a lung nodule, I highly recommend that they take the opportunity to get screened,” encourages Dr. Merry.

Although screenings are highly recommended, some people miss the chance for early detection for a number of reasons, including guilt. Dr. Merry explains, “With lung cancer, a lot of patients feel like they did it to themselves. Society tends to blame people with lung disease more than other types of cancer, but I want them to know that they didn’t do anything wrong. At St. Vincent’s, we discourage smoking but the truth is, it’s a legal practice. Because smoking is accepted in our culture, we shouldn’t throw blame at people. Anyone with a nodule should get a screening, and I am lucky that we are able to offer that here.”

Whether the nodule is benign or not, the staff at St. Vincent’s ensures that each patient leaves with peace of mind or at least a specific course of action for next steps. To ease their anxiety, Dr. Merry says, “The first thing I do is tell patients to stop Googling. Unfortunately, there aren’t many articles out there with positive endings about lung nodules - only worst-case scenarios. Reassuring our patients is important. We have a strong multidisciplinary team, so no matter what our patients have, we will help them get through it and get the treatment they need.”

She goes onto say, “If it’s not cancer then our team will track the nodule. But if it is, we connect patients with the best people for the job. Even if the nodule isn’t cancerous, being told you have a nodule is scary. We want to take the fear out of it.”

No matter the outcome, there’s always a bright side of being involved in such a crucial part of the patient’s health. “We often have patients come into our clinic scared after mapping out their lung nodule journey through cancer and radiation when it turns out all they needed was the surgery. It’s a huge burden lifted.”

She continues, “We are so lucky to get to treat our patients. The good thing about surgical oncology is that we can take in a patient with cancer one day and release them cancer-free the next. And when you get to tell a patient they don’t have cancer, it’s a happy appointment. It’s extremely rewarding.”

At Providence, we treat the whole person, not just the disease. Out of the many rewards of treating patients and watching them heal, one aspect of being involved in St. Vincent’s stands out. According to Dr. Merry, “The things I love most about being a thoracic surgeon, besides helping my patients, is that I work with many different types of patients from many different backgrounds. Over the years I’ve gotten to know them. And building those special relationships and creating that level of trust is something we strive for at Providence St. Vincent’s.”

In this issue: Information about the comprehensive array of cardiovascular and cardio-metabolic services we currently offer that have led to exceptional patient outcomes, and it details the major impr

Providence St. Joseph Health is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and affiliated services guided by a Mission of caring that the Sisters of Providence and the Sisters of St. Joseph of Orange began in the West nearly 160 years ago.